Effect of moderate or intensive disease management program on outcome in patients with heart failure: coordinating study evaluating outcomes of advising and counseling in heart failure (COACH)

Tiny Jaarsma, Martje van der Wal, Ivonne Lesman-Leegte, Marie Louise Luttik, Jochem Hogenhuis, Nic J. Veeger, Robbert Sanderman, Arno W. Hoes, Wiek H. van Gilst, Dirk J.A. Lok, Peter H J M Dunselman, Jan G P Tijssen, Hans L Hillege, Dirk J. van Veldhuisen

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Abstract

BACKGROUND: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.

METHODS: The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.

RESULTS: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60).

CONCLUSIONS: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.

Original languageEnglish
Pages (from-to)316-324
JournalArchives of internal medicine
Volume168
Issue number3
Publication statusPublished - 11 Feb 2008
Externally publishedYes

Keywords

  • nursing
  • heart failure

Cite this

Jaarsma, Tiny ; van der Wal, Martje ; Lesman-Leegte, Ivonne ; Luttik, Marie Louise ; Hogenhuis, Jochem ; Veeger, Nic J. ; Sanderman, Robbert ; Hoes, Arno W. ; van Gilst, Wiek H. ; Lok, Dirk J.A. ; Dunselman, Peter H J M ; Tijssen, Jan G P ; Hillege, Hans L ; van Veldhuisen, Dirk J. / Effect of moderate or intensive disease management program on outcome in patients with heart failure : coordinating study evaluating outcomes of advising and counseling in heart failure (COACH). In: Archives of internal medicine. 2008 ; Vol. 168, No. 3. pp. 316-324.
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title = "Effect of moderate or intensive disease management program on outcome in patients with heart failure: coordinating study evaluating outcomes of advising and counseling in heart failure (COACH)",
abstract = "BACKGROUND: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.METHODS: The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.RESULTS: Mean patient age was 71 years; 38{\%} were women; and 50{\%} of patients had mild HF and 50{\%} had moderate to severe HF. During the study, 411 patients (40{\%}) were readmitted because of HF or died from any cause: 42{\%} in the control group, and 41{\%} and 38{\%} in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29{\%} of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95{\%} confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60).CONCLUSIONS: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.",
keywords = "nursing, heart failure, verpleegkunde, hartfalen",
author = "Tiny Jaarsma and {van der Wal}, Martje and Ivonne Lesman-Leegte and Luttik, {Marie Louise} and Jochem Hogenhuis and Veeger, {Nic J.} and Robbert Sanderman and Hoes, {Arno W.} and {van Gilst}, {Wiek H.} and Lok, {Dirk J.A.} and Dunselman, {Peter H J M} and Tijssen, {Jan G P} and Hillege, {Hans L} and {van Veldhuisen}, {Dirk J.}",
year = "2008",
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language = "English",
volume = "168",
pages = "316--324",
journal = "Archives of internal medicine",
issn = "0003-9926",
publisher = "American Medical Association",
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}

Jaarsma, T, van der Wal, M, Lesman-Leegte, I, Luttik, ML, Hogenhuis, J, Veeger, NJ, Sanderman, R, Hoes, AW, van Gilst, WH, Lok, DJA, Dunselman, PHJM, Tijssen, JGP, Hillege, HL & van Veldhuisen, DJ 2008, 'Effect of moderate or intensive disease management program on outcome in patients with heart failure: coordinating study evaluating outcomes of advising and counseling in heart failure (COACH)' Archives of internal medicine, vol. 168, no. 3, pp. 316-324.

Effect of moderate or intensive disease management program on outcome in patients with heart failure : coordinating study evaluating outcomes of advising and counseling in heart failure (COACH). / Jaarsma, Tiny; van der Wal, Martje; Lesman-Leegte, Ivonne; Luttik, Marie Louise; Hogenhuis, Jochem; Veeger, Nic J.; Sanderman, Robbert; Hoes, Arno W.; van Gilst, Wiek H.; Lok, Dirk J.A.; Dunselman, Peter H J M; Tijssen, Jan G P; Hillege, Hans L; van Veldhuisen, Dirk J.

In: Archives of internal medicine, Vol. 168, No. 3, 11.02.2008, p. 316-324.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effect of moderate or intensive disease management program on outcome in patients with heart failure

T2 - coordinating study evaluating outcomes of advising and counseling in heart failure (COACH)

AU - Jaarsma, Tiny

AU - van der Wal, Martje

AU - Lesman-Leegte, Ivonne

AU - Luttik, Marie Louise

AU - Hogenhuis, Jochem

AU - Veeger, Nic J.

AU - Sanderman, Robbert

AU - Hoes, Arno W.

AU - van Gilst, Wiek H.

AU - Lok, Dirk J.A.

AU - Dunselman, Peter H J M

AU - Tijssen, Jan G P

AU - Hillege, Hans L

AU - van Veldhuisen, Dirk J.

PY - 2008/2/11

Y1 - 2008/2/11

N2 - BACKGROUND: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.METHODS: The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.RESULTS: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60).CONCLUSIONS: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.

AB - BACKGROUND: Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.METHODS: The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.RESULTS: Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60).CONCLUSIONS: Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups. Clinical Trial Registry http://trialregister.nl Identifier: NCT 98675639.

KW - nursing

KW - heart failure

KW - verpleegkunde

KW - hartfalen

M3 - Article

VL - 168

SP - 316

EP - 324

JO - Archives of internal medicine

JF - Archives of internal medicine

SN - 0003-9926

IS - 3

ER -